Freedom Camping Infringement Waiver Request

*- indicates required field.

Please ensure you refer to the Freedom Camping Bylaw 2019, before completing this form.

Infringement Notice Details

Infringement Notice Number(s) *

Offence Date *

Vehicle Make *

e.g. Holden, Ford, Subaru

Vehicle Registration *

Full Name of Registered Owner *

Address of Registered Owner *

Full Name *

Date of Birth *

Physical Address *

Postal Address (if different) (optional)

Contact Phone Number *

Email *

Please provide reasons for your waiver request (optional)

Please upload any supporting documentation or photos (optional) HelpText

Upload

(pdf, doc, docx or jpg)

Certification *

I hereby certify that, to the best of my knowledge and belief, the information provided above is true and correct.